EMT11KDL
Forum Asst. Chief
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Ouch, hope the bloke hit by the train is ok. Tourniquets were introduced in NZ in 2009 and the 3 times I have seen then used I must say I felt they were not appropriate eg not life threatening haemorrhage uncontrollable with direct pressure
I think that's the worry -- then again, it seems like there's lots of data that has come from military use in Iraq and Afghanistan indicating that limbs aren't irretrievable after tourniquet use. Not sure if that is reflective of unnecessary application (say, bleeds that are controllable pre-hospitally via direct pressure but a provider applies a tourniquet) or not.
Bleeding Control Shock Management (Current)
- Apply direct pressure
- Apply tourniquet
Our assistant medical director (who is a military trauma surgeon and spoke at the most recent trauma symposium) has told me multiple times that tourniquets can be left on for up to 6 hours and still be reversible. So for prehospital, unless you're somewhere very rural and in the middle of a blizzard, I wouldn't be too concerned. I'm not saying go straight to tourniquets on any significant extremity bleed, but if you have coworkers that you feel put them on unnecessarily once in a while, I don't think it would be too detrimental.
Ooh I haven't seen the new NREMT skill sheet for this, thanks!
No problem! I'm not sure when they instituted the change, but I'm sure someone who knows will chime in. You can download the skill sheet directly from here: https://www.nremt.org/nremt/about/psychomotor_exam_emt.asp
Has to be a proper tourniquet.
If it is too loose, it will potentially speed bleeding by sealing off just veins (lower pressure than arteries) and cross-circulatory routes will pump more blood to the bleeder, like a phlebotomist's TK.
If it is too narrow, too tight, or too close to the wound it will crush tissue irretrievably.
And it is to be used when other modes don't work.
A good tool we had taken away because it was abused partly because first aid sources taught people to improvise. (Ever actually try to make one out of a belt?).
Back to lurk mode.
Our assistant medical director (who is a military trauma surgeon and spoke at the most recent trauma symposium) has told me multiple times that tourniquets can be left on for up to 6 hours and still be reversible. So for prehospital, unless you're somewhere very rural and in the middle of a blizzard, I wouldn't be too concerned. I'm not saying go straight to tourniquets on any significant extremity bleed, but if you have coworkers that you feel put them on unnecessarily once in a while, I don't think it would be too detrimental.
I was told the skill sheets changed in late 2011/ early 2012, not sure exactly of which. But our instructors said we were the first class that they were having to teach tourniquets to again.No problem! I'm not sure when they instituted the change, but I'm sure someone who knows will chime in. You can download the skill sheet directly from here: https://www.nremt.org/nremt/about/psychomotor_exam_emt.asp